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Nutritional Diseases
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Chelsea Kesty, Madeline Hooper, Erin McClure, Emily Chea, Cynthia Bartus
Management: This may be treated with supplements of pyridoxine 50–100 mg/day. Patients taking isoniazid should supplement with pyridoxine 30–50 mg/day for the duration of their treatment to prevent deficiency.
Prenatal Care
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Gabriele Saccone, Kerri Sendek
There is insufficient evidence to evaluate pyridoxine supplementation during pregnancy [85]. There are few trials reporting few clinical outcomes, and mostly with unclear trial methodology and inadequate follow-up. There is not enough evidence to detect clinical benefits of vitamin B6 supplementation in pregnancy and/or labor other than one trial suggesting protection against dental decay [86]. For the aim of decreasing dental decay or missing/filled teeth, pyridoxine supplementation 20 mg/day (lozenges or capsules) is associated with a decreased incidence of these outcomes in pregnant women [86]. Pyridoxine has been used in the management of nausea and vomiting in pregnancy. It is now considered category A in combination with doxylamine as Diclegis, which is the only FDA-approved treatment for nausea and vomiting of pregnancy. Studies done for FDA approval of the drug showed no adverse outcomes and demonstrated safety and good tolerance by women when used in the recommended dose of up to 4 pills (10 mg/10 mg) per day (see Chap. 9 in Maternal-Fetal Evidence Based Guidelines).
B Vitamins
Published in Luke R. Bucci, Nutrition Applied to Injury Rehabilitation and Sports Medicine, 2020
Regardless of cause, vitamin B6 supplementation must be conducted carefully. Do not administer daily doses greater than 500 mg for any time period greater than 1 week. Do not administer daily doses of pyridoxine between 100 to 500 mg for more than 1 to 2 months. Daily doses of 100 mg for long time periods (up to 1 year) appear to be safe for most persons. However, after 1 year, a subset of patients may exhibit pyridoxine toxicity. It is not well known if tapering of pyridoxine doses from 100 mg daily to lower doses would maintain prevention of deficiency. It is known that doses of 10 mg or less usually do not normalize deficient vitamin B6 functions. Addition of other nutrients with pyridoxine (other B vitamins singly or in combination, magnesium, zinc) did not affect toxicity findings. It is highly recommended to employ functional testing for vitamin B6 status before initiation of oral doses in excess of 100 mg daily. If status is not functionally deficient, it is wise to prevent pyridoxine intakes over 50 mg daily.
Peritoneal tuberculosis caused by intravesical instillation with Bacillus Calmette-Guérin (BCG) following nephroureterectomy in a patient with bladder and upper tract urothelial cancer: a case report
Published in Acta Clinica Belgica, 2023
Charlotte Allaeys, Pieter De Backer, Karel Decaestecker, Camille Berquin, Karen Decaestecker, Steven Callens, Charles Van Praet
A percutaneous ascites punction demonstrated an initial negative culture and normal creatinine count, ruling against persistent urinary leak. An exploratory robot-assisted laparoscopy was performed 2 days later. A large amount of ascites was extracted and sent for culture. The peritoneum was found to be intact with no urinary leak present. However, the peritoneum was diffusely thickened and white plaques were seen and biopsied (see Figure 3). The peritoneum overlying the left internal iliac artery was opened and the bladder was filled, exposing a small residual bladder leak that was sutured using a V-loc 3.0 suture (©Medtronic, Minneapolis, USA). A bladder catheter and an abdominal drain were left in place. While the acid-fast staining of the ascites was negative, biopsy of the suspicious plaques confirmed peritoneal tuberculosis based on the presence of acid-fast rods and a positive GeneXpert M. tuberculosis molecular assay. More specific, rifampicin-sensitive Mycobacterium bovis was detected in culture. A two-month triple treatment with isoniazid, rifampicin and ethambutol was initiated, followed by a 7-month dual treatment with isoniazid and rifampicin. Weekly pyridoxine was started to prevent vitamin B6 deficiency.
Chapter 9: Pediatric tuberculosis
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2022
Rachel Dwilow, Charles Hui, Fatima Kakkar, Ian Kitai
In children under the age of 10 years, or weighing less than 30 kg, the recommended dose of INH is 10-15 mg/kg/day (maximum 300 mg).23 Administration is affected by food and INH is better absorbed on an empty stomach. Fat and sugars reduce its absorption.61 A sorbitol-based suspension avoids this problem but may cause diarrhea, especially in children weighing more than 5 kg.62 Crushed pills are ideally mixed with water but few children will accept this and administration with small amounts of food/liquid is often suggested.63 Doses of INH above 10 mg/kg/day are sometimes associated with pyridoxine deficiency. Pyridoxine supplementation should be given to children on meat and milk-deficient diets, breastfed infants, those with nutritional deficiencies, children with symptomatic HIV infection and adolescents who are pregnant or breastfeeding.23 Breastfed infants of mothers who are taking INH with supplementary pyridoxine but who themselves are not receiving INH do not need supplementary pyridoxine.
Suicide attempt with isoniazid in adolescents receiving tuberculous prophylaxis: three cases
Published in Paediatrics and International Child Health, 2021
A 15-year-old girl was admitted to the ED with tonic-clonic seizures and became unconscious immediately after admission with a GCS of 3/15. She had ingested 9 g INH (160 mg/kg). To secure her airway, she was intubated and positive pressure ventilation was commenced. Intubated gastric lavage was subsequently undertaken and activated charcoal was administered. Blood gas analysis demonstrated pH 6.9, pCO2 50 mmHg and HCO3 10 mmol/L. Blood LDH was 1403 U/L, CK 34,908 IU/L, AST 345 U/L and ALT 96 U/L. Midazolam and NaHCO3 were administered intravenously. Pyridoxine 5 g was given orally with a nasogastric tube since IV pyridoxine was not available in the hospital at the time. The patient was transferred to the paediatric intensive care unit and was on mechanical ventilation for 12 hours. On Day 2 in hospital, she had no further seizures. Pyridoxine was continued for 5 days. By Day 10 of hospitalisation, the CK and AST/ALT levels had returned to normal and she was discharged home on Day 12.